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APPLICATION FOR PERMIT
HEATING - VENTILATING - AIR CON0I110NING
COUNTY OF LOS ANGELES BUILDING
DEPARTMENT`OF COUNTY ENGINEER ADDRESS '--
BUILDING AND SAFETY DIVISION LOCALITY LG
NEAREST
CROSS ST
FOR APPLICANT TO FILL IN OWNER
(PRINT OR TYPE ONLY)
MAIL
NO TYPE&SIZE OF EQUIPMENT FEE ADDRESS �L'7
SEE BACK OF APPLICATION �y
CITY U1 TEL NO
FORCE AIR FURNACE BTU
COMPRESSOR, BTU
7 CONTRACTOR
ADDRESS,[qo Nil e-'--d a,w0
VENTILATION FAN CITY / TEL NO
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LIST ALL OTHERS BELOW STATE- LIC
LICENSE NO NO ��7 CLASS(--')--
—' _ DISTRICT NO GROUP ZONE PROC SED BY
INSPECTION RECORD
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Plan check fee See reverse z
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101 11 11-1 Q
PLAN CHECK APPLICANT
NAME
ADDRESS
CITY - TEL NO
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALLORDINANCES AND LAWS REGULATING HEATING VEN11 APPROVALS DATE INSPECTOR'S SIGNATURE
LATING AIR CONDITIONING
ROUGH
I HEREBY CERTIF THAT AM NOT ACTING IN CATION
OF CHAPTER 9 DIVISI 3 OF THE BUSINESS AN F SSIONAL FINA
CODE OF THE STATE OF ALIFORNIA
SIGNATUREPERMIT VALIDATION CK M 0 CASH
OF PERMITTEE
PLAN CHEC V LIDATION CK M o 615H
771rl-mAR 1841 1 2.00 ®90
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